Licensing and Multi-State Practice for Telehealth

Licensing is one of the most important—and complex—elements of telehealth credentialing. Because telehealth allows you to serve patients across state lines, understanding and managing multi-state licensure is essential for legal, compliant, and reimbursable virtual care.

Why Is Licensing Different for Telehealth?

• Location Matters: In telehealth, you must be licensed not only in your home state, but also in every state where your patients are physically located at the time of service.

• State-by-State Rules: Each state has its own licensing board, requirements, and telehealth regulations. There is no single “national license” for telehealth.

• Compacts and Expedited Pathways: Some states participate in licensure compacts that make it easier to obtain multiple state licenses, but you must still apply and be approved in each state.

Key Options for Multi-State Licensure

1. State Licensure

• Direct Application: Apply for a license in each state where you wish to see patients.

• Requirements Vary: Each state may require different documentation, fees, background checks, and continuing education.

2. Interstate Licensure Compacts

• Interstate Medical Licensure Compact (IMLC): For physicians, this compact streamlines the process of obtaining licenses in participating states.

• Nurse Licensure Compact (NLC): For registered nurses and LPNs/LVNs, this allows practice in other compact states with a single multistate license.

• Other Compacts: Some allied health professions have their own compacts (e.g., PSYPACT for psychologists).

3. Temporary and Emergency Licenses

• Some states offer temporary or expedited licenses for telehealth, especially in response to public health emergencies. Always verify current rules, as these can change.

Best Practices

• Track All Licenses: Maintain a list of all active state licenses, expiration dates, and renewal requirements.

• Check State Telehealth Laws: States may have unique consent, prescribing, or technology rules for telehealth.

• Update Payers: Ensure your payer enrollment reflects all states where you are licensed and practicing.

• Stay Informed: Laws and compacts evolve—review state board and compact websites regularly.

Common Pitfalls

• Practicing Without a License: Providing telehealth services to a patient in a state where you are not licensed can result in disciplinary action, claim denials, and legal penalties.

• Assuming Compacts Cover All Needs: Even with a compact, you must still apply and be approved for each state license.